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Comparison of hemorrhagic and ischemic stroke after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 55, pages 2087–2097 (2020)Cite this article

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Abstract

Stroke is an important complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Nevertheless, few studies have been published to analyzed the occurrence and prognosis of stroke after allo-HSCT. From January 2007 to December 2018 in Peking University People’s Hospital, 6449 patients received HSCT and there were 2.3% of patients diagnosed with stroke after allo-HSCT (hemorrhagic: 1.0%, ischemic: 1.3%). The median time to hemorrhagic and ischemic stroke after HSCT was 161 days and 137 days, respectively. In total, 8.4% of patients experienced neurological sequelae. The outcome was much worse in patients with stroke than in control subjects. The comparison of prognosis showed no statistical differences between patients with hemorrhagic stroke and those with ischemic stroke. Significant risk factors for hemorrhagic stroke were pretransplant central nervous system leukemia (CNSL), and delayed platelet engraftment. Risk factors associated with the occurrence of ischemic stroke included high-risk disease, prior venous thromboembolism (VTE), grade III–IV acute graft-versus-host disease (aGVHD), and thrombotic microangiopathy (TMA). Haplo-identical transplantation was not a risk factor for stroke and had no impact on the prognosis compared with HLA-matched HSCT. Altogether, these results show that stroke is a severe complication after allo-HSCT. The prognosis of posttransplant stroke did not differ between hemorrhagic and ischemic stroke.

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Fig. 1: Flow chart of case selection.
Fig. 2: Comparison of prognosis between patients with and without stroke.

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Acknowledgements

The authors would like to thank all the patients and medical staff who took part in the study. The authors also thank the department of medical record library for providing data. This work was supported by National Natural Science Foundation of China (No. 81670116), Key Program of National Natural Science Foundation of China (No. 81730004), Beijing Natural Science Foundation (Nos. 7171013, H2018206423), Beijing Municipal Science and Technology Commission (No. Z171100001017084), the National Key Research and Development Program of China (No. 2017YFA0105500, No. 2017YFA0105503), and the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (81621001).

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  1. These authors contributed equally: Xuan Cai, Hai-Xia Fu

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing, China

    Xuan Cai, Hai-Xia Fu, Xiao-Dong Mo, Yu Wang, Yuan-Yuan Zhang, Jin Wu, Wei Han, Fei-Fei Tang, Ruo-Yun Gui, Huan Chen, Yao Chen, Peng Zhao, Chen-Hua Yan, Jing-Zhi Wang, Yu-Hong Chen, Ying-Jun Chang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

  2. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

    Xuan Cai, Hai-Xia Fu, Xiao-Dong Mo, Yu Wang, Yuan-Yuan Zhang, Jin Wu, Wei Han, Fei-Fei Tang, Ruo-Yun Gui, Huan Chen, Yao Chen, Peng Zhao, Chen-Hua Yan, Jing-Zhi Wang, Yu-Hong Chen, Ying-Jun Chang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

  3. Collaborative Innovation Center of Hematology, Peking University, Beijing, China

    Xuan Cai, Hai-Xia Fu, Xiao-Dong Mo, Yu Wang, Yuan-Yuan Zhang, Jin Wu, Wei Han, Fei-Fei Tang, Ruo-Yun Gui, Huan Chen, Yao Chen, Peng Zhao, Chen-Hua Yan, Jing-Zhi Wang, Yu-Hong Chen, Ying-Jun Chang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

  4. National Clinical Research Center for Hematologic Disease, Beijing, China

    Xuan Cai, Hai-Xia Fu, Xiao-Dong Mo, Yu Wang, Yuan-Yuan Zhang, Jin Wu, Wei Han, Fei-Fei Tang, Ruo-Yun Gui, Huan Chen, Yao Chen, Peng Zhao, Chen-Hua Yan, Jing-Zhi Wang, Yu-Hong Chen, Ying-Jun Chang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

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Cai, X., Fu, HX., Mo, XD. et al. Comparison of hemorrhagic and ischemic stroke after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 55, 2087–2097 (2020). https://doi.org/10.1038/s41409-020-0903-8

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